A Perimenopause Survivor’s Guide - The truth about hormone fluctuations and treatment options.

When it comes to menopause, there is some good news: It only lasts for a day. After 365 days menstruation free, the 366th is menopause, and then women are considered postmenopausal. The experience of all the months leading up to it are actually the effects of being perimenopausal. 

“As women finish their childbearing years, the ovaries slowly stop producing estrogen, progesterone and testosterone,” says Dr. Elizabeth Louka, an OB-GYN, “They gradually taper off and, in that transitional period, some women experience erratic fluctuations of hormones that create symptoms, some of which are severe.”

Symptoms can include insomnia, acne, weight gain, irregular periods, hot flashes and night sweats. While the average age for menopause is 51, women can begin feeling perimenopausal symptoms in their late 30s. By age 45, most are getting at least a taste of them. 

Because “perimenopause” is a little-used term, women don’t immediately understand what’s happening. Some patients think they may be pregnant or re-experiencing puberty. The reality is that the climate has changed. You’re at a new level of the mountain. You need new boots and a new map.

Unfortunately, there’s no forecast for perimenopause. The unpredictability of perimenopause only adds frustration. Blood and saliva tests can give a snapshot of hormone levels, but they’re constantly in flux. “Studies have looked at estrogen levels, and it’s not a steady decline,” says Louka. “They can be elevated one day and decreased the next day. Progesterone and testosterone are not in unison with each other, either. I think that’s what makes the symptoms so expressed.”

Dr. Lisa Freedman, who practices holistic medicine in Villanova, explains that estrogen, progesterone and testosterone are not the only hormones that create perimenopausal symptoms. Cortisol, follicle-stimulating hormone (FSH), dehydroepiandrosterone (DHEA) and lutropin (LH) affect ovulation and women’s overall health. “Of course, it’s a complicated, delicate system,” Freedman says. “We’re women.”

Women who have their weight, blood pressure, cholesterol and heart rate under control may have an easier time dealing with perimenopause. On the other hand, there are superwomen out there, raising their family and/or working and taking care of everyone but themselves. They hit a wall and crash, so to speak.

Natural bioidentical hormone therapy is one of the most effective treatments for symptoms. Available in oral capsules, injectables, and creams, bioidentical hormones are made at compound pharmacies. Dosages are tweaked based on patients’ responses. 

Hormone therapy initially proved controversial when a Women’s Health Initiative study abruptly stopped it in 2002 because participants were determined to be at elevated risk for heart disease and breast cancer. That study only reviewed synthetic hormones produced by large pharmaceutical companies.  Since then, additional research has been conducted, and the WHI released its full findings in 2013. That the report clarified when hormone therapy should be used and for which patients.  Generally, bio-identical hormone therapy (BHRT) doesn't cause the potential adverse side-effects of synthetic hormones.